Thursday, September 24, 2009

"Fixing" the wrong problem

One of the outcomes Obamacare is supposed to achieve is to reduce the number of visits to the emergency room. The thinking is that many uninsured people use the ER in lieu of regular doctor's visits or put off going to the doctor until the condition worsens, necessitating an ER visit. Not so says a Journal of the American Medical Association study.
For a study reported in the October 22, 2008 Journal of the American Medical Association (JAMA), researchers at the University of Michigan evaluated 127 peer-reviewed articles that made claims about the impact of uninsured patients on emergency room crowding. They concluded that “available data do not support assumptions that uninsured patients are a primary cause of overcrowding, present with less acute conditions than insured patients, or seek [emergency room] care primarily for convenience.”

The JAMA study also found that patients with public insurance, such as Medicaid and Medicare, are more likely to crowd into emergency rooms for minor complaints than are the uninsured. Only about 17 percent of E.R. visits in the United States in the last year studied were by uninsured patients, about the same as their share of the population.

This is both interesting and counterintuitive. More importantly, it suggests that we're crafting health care reform based on faulty assumptions. As the authors of the study note,

If we attempt to solve emergency overcrowding by creating policies based on inaccurate assumptions, common knowledge, or what ‘everybody knows,’ we will waste limited resources, fail to address the root causes of the problem, and potentially increase the barriers to care faced by 47 million uninsured Americans.”

In his inauguration speech, Obama promised to let the facts, not ideology guide his policies. Given that this study was release almost a year ago, I think it's time he scratched this item off of his list of talking points.

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